This post originally appeared on Hack Diabetes.
“I want daddy to do it.”
Bella, age six, was stark naked as she uttered the words. Her tiny hands were clenched into fists, and she stared at me pleadingly with tear filled eyes. Her expression mirrored that of her father, Chris, who was sitting cross legged on the ground next to us. Meanwhile, I was on my knees, holding a pistol-like medical device limply by my side, feeling like some sort of evil monster.
“Bella, sweetie, we told you,” said daddy in his best, most soothing voice. “Samantha is changing your pump site today. You have to let her try. Please?”
“Nooo,” she wailed, the suggestion barely out of his mouth. She turned her fists backwards to shield her exposed rear where, moments earlier, I attempted to align the menacing contraption, which she was now eyeing with great intensity.
Her dread, though highly inconvenient, was justified. If she allowed it, the apparatus would pierce her skin with a long needle, leaving behind a few millimeters of plastic tubing. We would then connect the tube to an insulin drip, which she would be forced to wear on a small pack around her waist at all times—the synthetic solution to the destruction of her body’s beta cells when she was just a baby. The doctors called it type 1 diabetes, but Bella just called it unfair.
I was also diagnosed with T1D as an infant, which perhaps made the situation worse. I understood her trepidation completely, while also being the source of her despair. As one of my fingers inched idly toward the trigger on the insertion device, Bella—watching me like a hawk—flinched horribly, swatted the tool out of my hands and onto the floor, and erupted into renewed hysterics.
My chest ached watching her cry. She was visibly shaking; her innocent brain trying desperately to comprehend what she had done to deserve such terrible punishment. Somewhere in the depths of my mind, a visual of a familiar little girl with bright blue, watery eyes manifested. A younger version of my mother appeared above her holding an insulin-filled syringe, begging the girl to stop squirming.
The girl sobbed, “Mommy, no, please!” and drew her knees tighter toward her chest. I nearly dropped the device again in an act of surrender, whatever resolve I had mustered at the start of the task fading along with the memory.
Chris and I exchanged dejected glances. I knew he, too, would give anything to alter the circumstances so that his beautiful little girl was no longer subjected to an endless procession of pokes and prods. Yet we had an obligation to her health—he as her parent, and me as her babysitter—though such logic was meaningless in the face of her immediate fear.
“Bella,” Chris began once more, and this time his voice was firm.
“Samantha is going to change your site this weekend—whether you like it or not—because mommy and I will be on vacation. Wouldn’t you rather she practiced while we’re still here?”
“No!” she screamed with finality, and it was clear there was no hope of me succeeding. Defeated, I passed the insertion device to Chris and left the room to assuage his daughter’s growing fear that I would attack her the minute her white-knuckled fists unclenched.
A short while later, Bella returned to her bedroom fully-clothed with a crisp pump site on her butt, gnawing forlornly on the lollipop she had been promised as collateral for her cooperation. Back in the kitchen, I tried my best to convince Chris that he and his wife need not cancel their trip—their first ever since Bella’s diagnosis— assuring him that I would devise a genius strategy for Saturday when her next site change was due.
“You have my permission to use whatever means necessary,” Chris offered. “Treats, gifts, lies. Whatever it takes. If you promise her something that you can’t immediately deliver, we’ll take care of it when we’re home.”
“Don’t worry,” I said with all the confidence I could muster. The echo of my younger self weeping at the sight of a syringe lingered below the surface, but I continued: “I’m sure I can handle it. I’m sure everything is going to be just fine.”
Only I was exceptionally, most certainly, unsure. How was I going to convince headstrong Bella to allow me anywhere close when our test run had gone so awry? Whatever trust I had gained as her babysitter evaporated the minute her dad passed me a loaded needle-gun with her name on it.
Though I willed it not to come, the weekend abruptly arrived. Bella’s parents departed with the sole instruction to text or call any time for anything (“no really, anything”) and I halfheartedly assured them that they had absolutely nothing to fear. After tucking Bella into bed, I spent Friday evening imagining various worst case scenarios before eventually drifting into a heavy sleep, punctured only by visions of giants wielding skyscraper-sized syringes.
The next morning, Bella sat across from me at the kitchen counter shoveling cereal into her mouth, talking animatedly about her friend Sasha who had once succeeded in lodging a cocoa puff into her left nostril.
“That’s crazy,” I said, but I was hardly listening. Instead, I was preparing my opening, though there seemed to be no good time. Bracing myself for the inevitable rebuttal, I began, “Hey, what do you think? Should we do your site change before or after dinner?”
She twirled her spoon in the air thinking for a moment, and then decided, “Mmm, after.” I breathed a sigh of relief, taking it as a positive sign that she had not challenged the idea outright.
The morning and afternoon passed without issue. We went to the park, played board games, had lunch, corrected a low, corrected a high, watched TV, and finally, had dinner. As Bella pressed me for dessert, I decided I could wait no longer.
“You can have dessert, but only after we do your site change.”
To my surprise, she nodded without contest, and headed toward the bathroom where I had placed a freshly primed insertion set by the sink.
When we arrived, she removed her pajama bottoms and turned her back to me with unnerving complaisance. As I aligned the device against her lower back, she craned her neck backwards and instructed to the top of my head, “Count down from ten before you do it.”
“Of course, whatever you want,” I said.
“And you have to say ‘zero.’ Don’t do it until you get to zero,” she added, sternly.
I pinky promised to follow her rules, and—once satisfied with the positioning—I began the requested countdown.
“Ten, nine, eight,” I recited.
Bella shifted nervously, watching my hands with the intensity of a cop staring down a perpetrator.
“…seven, six, five, four…”
She was now bouncing from leg to leg, biting her bottom lip. Her nervous movements made it difficult to hold the device in the correct spot, but I did not dare ask her to stop for fear of jeopardizing her compliance.
“…three, two, one!” and I pulled the trigger, but the positioning was all wrong. Bella leaped backwards with a curdling yelp as the tip of the needle jabbed her, missing its mark, but still delivering a sharp jolt of pain.
“Oh my gosh, I’m so sorry, sweetie! Are you okay?”
“You didn’t say zero!” she bawled, her face red and contracted, her sobs bellowing from her chest and echoing into the bathtub where she had collapsed in shock.
Whether or not she felt as much pain as she dramatized, I had completely botched the first attempt. This meant we would have to do it all over again. The only problem was that, this time, Bella was not quite so eager to participate. In fact, she was very much hysterical.
And so began a series of bribes for which I am not entirely proud.
“Mommy and daddy said that if you do a good job, they’ll take you to the toy store and buy you ANYTHING you want. What do you say?”
“No!” Bella wailed, her knuckles clenched in defense, snot and tears running down her pitiful face.
“Remember I promised you that dessert? Well, it’s waiting for you in the kitchen. All we have to do is get that site on you.”
“No!” she cried, and I caught her side-eyeing herself in the mirror, clearly impressed with her own performance.
“Bella,” I barked, changing tactics. “If you don’t turn around and let me put on your site, you’re grounded all day tomorrow. No TV. No iPad. Nothing.”
“I don’t care!” she spat.
She crossed her arms and stepped onto the toilet seat so as to position herself above me as I continued to kneel pathetically on the floor. Though tears were still leaking from her bloodshot eyes, she did not hesitate to reclaim control when presented with the opportunity. It was clear to both of us that I was completely powerless.
I scoured my brain for another bribe, another threat; but nothing came. The problem was that I understood exactly how she felt; utterly helpless and full of dread, the anticipation of the pain worse than the actual insertion. At least she trusted her father enough to know he would never hurt her intentionally, I thought. Unfortunately, I had not built enough rapport in this area to make her feel safe. Yet there was no alternative. We would have to sit here until she calmed down, even if it took all night, as I was the only adult in the vicinity trained in the procedure…
Suddenly, a brilliant, crazy idea hit me with such intensity I jumped to my feet. Though my mind was racing, I tried to speak as calmly as possible.
“Alright, Bella. I get it. You don’t want me to do it,” to which she nodded theatrically, wiping her eyes with the back of her hands.
“So I’m not going to.”
“Huh?” she said, forgetting that she was supposed to be acting victimized.
“I’m not gunna do it. I don’t want to hurt you or make you more upset.”
She glared at me suspiciously, her mind searching for the loophole.
“Then who will? Daddy said you need to do it,” she added, suddenly keen on following instructions.
“Well, I don’t want to anymore. But you can do it.”
“Yes, you. You’re going to do your own site change, Bella! What do you say?”
She clapped her hands to her mouth, and then a sly grin crept across her wet face.
“But…how? I’ve never done it before.”
“I’ll teach you. Here,” I said, and I placed the insertion device into her small hand to show her just how serious I was.
She cradled the tool with a mixture of fear and curiosity. Then, recalling all the times she had seen her father do it, she placed the prongs of the instrument delicately on her hip, angling the needle slightly, careful not to graze the trigger.
“Like this?” she asked.
“Up a little more,” I said, and I reached over gently to demonstrate. With some hesitancy, she allowed me to position her hands and adjust the device accordingly.
“There, that’s perfect.”
She admired her work and absorbed the compliment. Then, the smile faded from her face as it dawned on her that the next logical step was to release the needle.
“Go ahead,” I prompted.
“I’m scared,” she said.
“Okay. Well, if you don’t feel ready then I guess I’ll have to do it,” I suggested.
“No!” she yelled, and with amusement, I realized how quickly she had weighed the pros and cons of the situation, settling easily on the option where she had the most power.
Despite my continued compliments on her form, she could not muster the courage to pull the trigger even after several demonstrations. At her request, I obtained an additional insertion set and allowed her to pull and release the needle multiple times into my thigh so she could get a feel for the technique. Finally, after I could no longer justify another puncture wound, she felt confident enough to try again on herself.
“Okay, you’re gunna count down again,” she said. “And this time don’t forget zero!”
I agreed, and began the count, hoping this was finally it. As I hit four, however, Bella lost her nerve and dislodged the device, forcing us to begin the process once more. I was beginning to lose my patience, especially as it dawned on me that she had been without her insulin pump for nearly an hour.
“…seven, six, five…”
“Samantha, I’m scared!”
“…four, three, two…”
“I can’t do it!”
“Bella, please! I know you can do it. You got this, c’mon!”
She stared at her feet, clearly not believing me. Then, in almost a whisper, she asked, “Will you be proud of me if I do it?”
The purity of the question caught me off guard, and in spite of my frustration, I dropped to my knees, softening my expression.
“Oh, sweetie. If you do this, I will be so, so proud of you. As proud as I’ve ever been. And mommy and daddy will be, too. Just think about how wonderful it will be when you get to tell them you did your site change all by yourself!”
She beamed, and with fresh confidence instructed me to resume the countdown.
“Ten, nine, eight…”
Her grip was firm on the device, and her fidgeting had stopped.
A loud click perforated the air, Bella jumped slightly, and when I looked down, a fresh, but slightly red pump site glistened on her backside. She had broken her own rule, and pulled the trigger before I hit zero. Bella stared at me with her mouth open, equally shocked by her own gall, and I burst into tears.
“Why are you crying?!” Bella asked, chuckling.
“I don’t know! I’m just…I’m so proud of you!”
“They’re happy tears?” she asked.
“Yes, happy tears!” I said, wiping my face, and laughing, too.
We examined the site and confirmed it was functional (“Better than daddy’s, I think!”) Elated, I lifted her into the air, spun her around twice, and kissed her wet little face with my own. Back in the kitchen, Bella enjoyed a celebratory chocolate chip cookie, and I felt I deserved one, too.
On Sunday, her parents arrived back home looking much more relaxed than I had seen in ages. Bella bounded into their arms, where she was instantly swept up and attacked with many kisses. While bouncing a jovial Bella on his hip, Chris asked, “So? How did it go?”
Bella immediately interjected.
“I did it!”
“Did what, baby?” asked her mom.
“I did my own site change!”
“You did what?!” said Chris.
“I did my own site change!” repeated Bella proudly.
Her parents exchanged confused looks and turned to me for explanation. All I could do was smile and shrug.
“Yup. Told you,” said Bella. “I did my own site change. Oh! And Samantha cried. But don’t worry,” she added, quickly, “they were just happy tears.”